The Consistency of Combat Exposure Reporting and Course of PTSD in Vietnam War Veterans
|
|
- Alisha Blair
- 5 years ago
- Views:
Transcription
1 Journal of Traumatic Stress, Vol. 20, No. 1, February 2007, pp ( C 2007) The Consistency of Combat Exposure Reporting and Course of PTSD in Vietnam War Veterans K. C. Koenen Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA and Department of Psychiatry, Boston University School of Medicine, Boston, MA S. D. Stellman Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY B. P. Dohrenwend Department of Psychiatry, Columbia University and New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY J. F. Sommer, Jr. American Legion, Washington. D.C. J. M. Stellman Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY Self-reports of traumatic events are often used in clinical and epidemiologic studies. Nevertheless, research suggests combat exposure reports may be biased by posttraumatic stress disorder (PTSD) symptom severity, leading to an inflated dose-response relation between combat exposure and PTSD. The authors examined the consistency in combat exposure reports and their relation to PTSD symptoms in Vietnam Veteran American Legionnaires who responded to two mailed surveys (1984, 1998; N = 1,462). Combat exposure reports were highly reliable (test retest correlation = 0.87). However, changes in exposure reporting were related to changes in PTSD symptoms, specifically reexperiencing symptoms. The effect size of the dose-response relation attributable to changes in reporting was smaller for continuous than categorical measures. Findings are discussed in relation to recent controversies over veterans combat exposure reports. Posttraumatic stress disorder (PTSD) as a diagnosis originally developed out of research on the effects of combat exposure on Vietnam veterans. The strong doseresponse relation between severity of combat exposure and PTSD symptoms has been well-documented (Kulka et al., 1990; Snow, Stellman, Stellman, & Sommer, 1988). Recent research on Gulf War and Somali peacekeeping mission veterans, however, has found that war-zone exposure reporting changed over time, with changes correlated with changes in PTSD symptoms (King & King, Correspondenceconcerningthisarticle shouldbeaddressed to: J. M. Stellman, DepartmentofHealthPolicyandManagement,MailmanSchoolofPublicHealth, Columbia University, New York, NY jms13@columbia.edu. C 2007 International Society for Traumatic Stress Studies. Published online in Wiley InterScience ( DOI: /jts
2 4 Koenen et al. 1991; Roemer, Litz, Orsillo, Ehlich, & Friedman, 1998; Southwick, Morgan, Nicolaou, & Charney, 1997). These findings have raised questions about the dose-response relation between combat exposure reports and PTSD in Vietnam veterans. That is, the observed dose-response relation between Vietnam combat exposure and PTSD may be subject, at least in part, to recall bias. This study examines the consistency of combat exposure reports and their relation to changes in PTSD symptoms in a large community cohort of Vietnam theater veterans followed over a 14-year period. Measurement of war-zone exposure relies on respondents recall of their experiences, usually in response to closed, self-report questions about the presence or absence of various types of combat exposure, often in the form of checklists or a large list of items with fixed response categories (King et al., 2000; Roemer et al., 1998; Southwick et al., 1997). The reliability and validity of such self-report measures has long been a research issue (King & King, 1991). A large body of literature has documented the phenomenon of mood-dependent memory whereby an individual s recall of experiences is affected by current psychological state (Cohen, Towbes, & Flocco, 1988). Because combat exposure checklists often contain subjective items that may be reinterpreted according to the respondent s current psychological state, extension of the concept of current mood based bias to PTSD suggests that the recall of extreme combat exposure events could be biased by current PTSD symptomatology. Specifically, the presence or absence of PTSD could lead to differential reporting of negative past events. Reexperiencing the trauma through intrusive memories is part of the PTSD syndrome; therefore, such memories may be more accessible to individuals with more PTSD symptoms. We investigated the reliability of combat exposure reporting and its relation to PTSD symptoms in Vietnam theater veterans who participated in a mailed health survey in 1984 and Identical measures of combat exposure and PTSD were used in both surveys, allowing us to examine changes in combat exposure reporting over 14 years, a period much longer than that examined in other studies. Furthermore, although most studies documenting the dose-response relation between combat exposure reports and PTSD have focused on Vietnam veterans, differential recall has not been studied in this population. One report on reliability of combat exposure reporting found a 6-month test retest reliability of 0.84, but did not examine differential recall as a function of PTSD symptoms (Janes, Goldberg, Eisen, True, & Henderson, 1992). Vietnam veterans wartime experiences were very different from those of the Gulf War or Somali peacekeeping mission, two groups previously reported on with regard to recall bias. The Vietnam War was the longest war in American history ( ), involved many more troops, produced a much higher number of casualties, and received much less public support (Kulka et al., 1990). In addition, the Vietnam War has been depicted more frequently in the popular media than have these other conflicts. In this study, we posed the following three questions: What is the reliability of combat exposure reported 14 years apart? Are changes in combat exposure reports associated with changes in PTSD symptoms or presumptive PTSD diagnosis? What is the degree to which changes in combat exposure reports affect the dose-response relation with PTSD symptoms/diagnosis? METHOD Participants The cohort was originally surveyed in 1984 for a study of the health and well-being of American Legion members (Snow et al., 1988; J. M. Stellman, S. D. Stellman, & Sommer, 1988a, 1988b; S. D. Stellman, J. M. Stellman, & Sommer, 1988a, 1988b). The American Legion is the largest veterans organization in the country, with 2.8 million members. Between 850,000 and 900,000 served during the Vietnam War era, of whom approximately 40% served in the Vietnam theatre of operations. A random sample of 12,000 male members of the American Legion who in October, 1983, belonged to any American Legion Post in Colorado, Indiana, Maryland, Minnesota, Ohio, or Pennsylvania, was drawn from post rosters. Details of the sampling method are described elsewhere (S. D. Stellman et al., 1988a).
3 Combat Reporting and PTSD Course 5 The first wave of the survey (Time 1) achieved a response rate of 56.3%, with 2,860 (42%) having served in the Vietnam theatre. A small number of veterans were found to be ineligible after returning their questionnaires. In 1998, we undertook a methodological study of exposure to herbicides and sought to reconstruct the original cohort to develop an approach for controlling for psychosocial health effects in our herbicide health studies. We made extensive efforts to locate the 1984 random sample, especially those who had dropped their Legion membership in the interim or who may have died. These efforts included use of private tracing firms, online Yellow Pages, commercial name and address listings, accession of military record data from the National Personnel Records Center (U.S. National Archives and Records Administration, St. Louis, MO), and networking within the American Legion. Through these efforts, 8,088 eligible veterans were located. Time 2 Survey Procedures In 1998, a second questionnaire, nearly identical to the 1984 version, was mailed to 8,088 cohort members (Time 2) who included both veterans who responded to the Time 1 survey and those who did not. Nonrespondents to the Time 2 survey were followed-up with several repeat mailings and additional inquiries. We received responses from 4,490 men, for a response rate of 55.5%. Of the 4,490, 3,403 responded at both Time 1 and Time 2. The cohort studied in the present analysis consists of 1,462 veterans who (a) returned surveys at both Time 1 and Time 2, (b) served in the Vietnam theater, (c) had reports of combat exposure that could be evaluated, and (d) could be assessed as having PTSD at both time periods. The Institutional Review Board of the Columbia College of Physicians and Surgeons approved the study protocol, survey instruments, and explanatory cover letters for 1984 and The cover letter that accompanied the survey explained the purpose of the study and gave assurance that participation was voluntary, that responses would be maintained with strict confidence, and that the subject could withdraw at any time without prejudice. The survey development was described in more detail in previous reports (Koenen, Stellman, Stellman, & Somers, 2003; Snow et al., 1988; J. M. Stellman et al., 1988a, 1988b; S. D. Stellman et al., 1988a, 1988b). At both times, the questionnaires included items on demographic information and a detailed military service history (S. D. Stellman et al., 1988a). Vietnam combat exposure severity was assessed with an eight-question Likert-type scale with five possible responses that has previously been validated in studies of Vietnam veterans (Figley, 1978; Frye & Stockton, 1982; S. D. Stellman et al., 1988). The questions, covering the extent of enemy fire and life-threatening situational exposures, were summed with a total score ranging from 8 to 40. For these analyses, we use the data provided by the veterans in 1984 (Time 1) because it is closer in time to the events. Internal consistency of the combat exposure was excellent in the current study with Cronbach s alphas of 0.93 in 1984 and 0.95 in For comparability with our previous report, the scores were categorized as low (8 15), medium (16 25), or high (26 40), with 520 (38%), 566 (41%), and 291 (21%) in each combat category, respectively. Posttraumatic stress disorder symptoms were evaluated at both times using the 17-item 5-point Likert-type PTSD Symptom Frequency Scale (Snow et al., 1988) developed for the 1984 survey, and following the diagnostic criteria for PTSD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980). Veterans were asked how frequently they experienced each symptom in the past month with response options ranging from never to very often. Because the PTSD symptoms from the DSM-III were identical to those in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM- III-R; American Psychiatric Association, 1987), presumptive PTSD diagnosis was determined according to DSM- III-R criteria to make results comparable to other studies of Vietnam veterans (Yehuda & McFarland, 1995). That is, the veteran must report often or very often to experiencing one symptom in the intrusive reexperiencing cluster, three symptoms in the avoidance/numbing cluster, and two symptoms in the arousal cluster to meet diagnostic criteria.
4 6 Koenen et al. Statistical Analyses What is the reliability of combat exposure reporting over 14 years? To examine test retest reliability, Pearson correlation coefficients were calculated for the association between total combat exposure score at Time 1 and Time 2. As in Southwick et al. (1997) and King et al. (2000), we calculated four frequency distributions to describe the extent of change in the sample: (a) changes from nonendorsement to endorsement or shifts from never to rarely or more, (b) changes from endorsement to nonendorsement or shifts from rarely or more to never, (c) total number of changes in endorsement, and (d) any changes at all. We then examined whether participants changes in reporting altered their combat exposure category assignment, e.g., whether they moved from being assigned as low combat in 1984 and were reassigned as high combat in Are changes in combat exposure reports associated with changes in PTSD symptoms or presumptive PTSD diagnosis? Pearson correlations were used to test the association between PTSD symptoms at Time 2 and the number of changes in the combat exposure items over time. Next, we tested whether changes in specific PTSD symptom clusters were associated with changes in endorsement. To accomplish this, we used two ordinary least square regression models with difference scores for reexperiencing, avoidance, and arousal symptoms as the independent variables and number of items changed from never to endorsement and endorsement to never as the dependent variables. Finally, we examined distributions of changes in reporting by PTSD status. For this purpose, participants were classified into four groups according to whether and when they met criteria for PTSD diagnosis: (a) PTSD diagnosis attime1and2(n = 78), (b) PTSD diagnosis at Time 1 only (n = 94), (c) PTSD diagnosis at Time 2 only (n = 76), and (d) No PTSD diagnoses (n = 1214). We then conducted a 4 (PTSD Group) 2 (Time: 1984, 1998) analysis of variance (ANOVA). Time was a within-subjects variable, which tested whether combat reporting significantly changed over time. PTSD group was a betweensubjects variable, which tested whether change in exposure reporting over time differed by groups defined according to PTSD diagnosis. Univariate repeated-measures ANOVAs were conducted to examine change over time within a PTSD group when the Wilks s lambda was significant for the PTSD Group Time Interaction term. These analyses were conducted for the combat exposure total and each combat exposure item as dependent variables. The effect size for each group was calculated from the mean change (difference score) in the total combat score from Time 1 to Time 2, divided by the population standard deviation for the observed change in combat exposure total. (Effect sizes: 0.20 = small, 0.50 = medium, and 0.80 or more= large; Cohen, 1992). In this study, mean change was calculated to be consistent with direction, with positive change values corresponding to increased combat exposure reporting and vice versa. What is the degree to which changes in combat exposure reports affect the dose response relation with PTSD symptoms/diagnosis? We examined the effect of recall bias on the observed dose-response relation between combat exposure reports and PTSD in two ways. First, we treated combat as a categorical variable. We then regressed Time 2 PTSD diagnosis on combat exposure (low, medium, high) evaluated at Time 1, using a binary logistic model. Next, we regressed Time 2 PTSD on categorical combat exposure evaluated at Time 2. We then compared the odds ratios for the association between combat exposure at Time 2 and PTSD at Time 2 with the odds ratios for the association between combat exposure at Time 1 and PTSD at Time 2. This comparison gives a sense of the degree to which changes in combat exposure reports affect the observed dose-response relation between combat exposure and PTSD. We conducted a similar analysis treating combat exposure and PTSD as continuous variables. RESULTS At the time of the 1998 survey, the mean age was 52 years (SD = 5.38); 98.7% were non-hispanic White; 75.1% lived with a spouse or partner; 37.4% had a high school education or less, 40.9% had some college, and 20.9% had a college education or more; 68.5% had a family income of over $50,000 in In terms of branch of service,
5 Combat Reporting and PTSD Course % were in the Army, 10.3% the Navy, 10.7% the Air Force, 14.6% in the Marines, and 1.5% did not indicate their branch of service. Veterans who did not respond at Time 2 were not different on any demographic variables from those who responded. However, those who did not respond in 1998 had slightly lower combat exposure (M = 13.02, SD = 7.48) than those who responded at both times (M = 13.02, SD = 7.48), t(6154) = 2.07, p <.05. Those who did not respond also had higher PTSD symptoms in 1984 (M = 43.72, SD = 13.62) than those who responded (M = 37.37, SD = 14.54), t( ) = 13.69, p <.001. Reliability of Combat Reports What is the reliability of combat exposure reporting over 14 years? Scores on the total CES at Time 1 (M = 19.18, SD = 7.89) and Time 2 (M = 19.23, SD = 8.16) were highly correlated, r (1462) =.87, p <.001, indicating excellent test retest reliability. Table 1 presents the frequency distributions for the type and number of combat exposure changes in the sample. We found that 59.3% of respondents did not change from never to endorsement on any item, whereas 54.9% did not change from endorsement to never on any item. Most individuals made at least one change in one combat exposure item as only 6.3% of individuals responded identically to all items at both time periods. The distribution of respondents in combat exposure categories (low, medium, high) was highly consistent. The majority of respondents (77.2%) did not change combat exposure category. A minority (22.4%) made a one-step category change (e.g., from low to medium or vice versa). Only five individuals changed two categories. Combat Reports and PTSD Are changes in combat exposure reports associated with changes in PTSD symptoms or presumptive PTSD diagnosis? The correlations between PTSD symptoms in 1998 and the number of items changed from never to endorsement, r (1, 224) =.03, ns or from endorsement to never were not significant, r (1, 224) =.04, ns. A small but significant association was found between PTSD symptoms in 1998 and the number of items changed from never to endorsement or endorsement to never, r (1, 224) =.08, Table 1. Number of Responses Changed per Subject on Combat Exposure Measure From 1984 to 1998 (N = 1462) Type of change Never to endorsement Endorsement to never Either a Any change b Number of responses changed per participant N % N % N % N % Missing a Change from never to endorsement or from endorsement to never. b Any change of any degree, e.g., from never to endorsement or from rarely to often.
6 8 Koenen et al. Table 2. Number of Responses Changed per Subject on Combat Exposure Measure From 1984 to 1998 by Posttraumatic Stress Disorder (PTSD) Status Number of Never to endorsement Endorsement to never responses PTSD PTSD PTSD changed per Both times Time 1 only Time 2 only No PTSD PTSD PTSD PTSD participant (n = 78) (n = 94) (n = 76) (n = 1214) Both times Time 1 only Time 2 only No PTSD % 69.1% 53.9% 58.3% 60.3% 64.9% 59.2% 53.5% Missing p <.01. The association for the number of items changed at all was also significant, r (1, 224) =.30, p <.001. The regression results indicated that increases in reexperiencing (B = 0.02, SE = 0.01, β =.08), but not avoidance (B = 0.007, SE = 0.007, β =.03) and arousal (B = 0.01, SE = 0.008, ß =.05) symptoms were positively and significantly associated with the number of items changed from never to endorsement. Table 2 compares the number of items changed by individuals who did not have PTSD with those who had PTSD at either or both assessments. The proportion of participants in a group who changed at least one item in the combat exposure can be calculated by subtracting the percentage in the first row from 100. Of those with PTSD at both times, 32.1% changed at least one item from never to endorsement. The largest proportion of changes to endorsement was in the PTSD Time 2 only group (46.1%), with the smallest number in the PTSD Time 1 only group (30.9%). The largest proportion of changes from endorsement to never was in the No PTSD group (46.5%) and the smallest number in the PTSD Time 1 only group (35.1%). The respective proportions for the group with PTSD at both times and the PTSD Time 2 group were 39.7% and 40.8%. Figure 1 presents the repeated measures ANOVA results for comparison of the total CES combat score among the four PTSD diagnostic groups. The Time effect, Wilks s λ = 7.46, p <.01, and the PTSD Time Interaction, Wilks s λ = 15.52, p <.001 were both significant. Simple effects analyses indicated that CES total changed significantly for the PTSD at both times (p <.01; effect size = 0.33), PTSD Time 1 (p <.01; effect size = 0.34), andptsdtime2(p <.01; effect size = 0.38) groups. The change was in the direction of a decrease for the PTSD Time 1 only group, but manifested as an increase for the other groups. CES total did not change for the No PTSD group (effect size = 0.005). Table 3 presents the difference scores in standard deviation units and repeated measures ANOVA results for each combat item. The Time effect was significant for items 3, 4, and 6. The PTSD Time Interaction term was significant for all items. Simple effects analysis indicated that the mean score for combat items 3 (p <.001), 4(p <.001), 5 (p <.001), and 7 (p <.001) increased significantly for the group with PTSD at both times. The mean score for combat items 4 (p <.05), 5 (p <.05), 6(p <.05), 7 (p <.001), and 8 (p <.001) decreased significantly for the PTSD Time 1 group. The mean score
7 Combat Reporting and PTSD Course 9 Mean Combat Total Time 1 30 Mean Combat Total Time 2 25 Mean score PTSD Both Timesa b c d PTSD Time 1 Only PTSD Time 2 Only No PTSD Figure 1. Mean value of total combat score at Time 1 (1984) and Time 2 (1998) by posttraumatic stress disorder (PTSD) group. a Significant time effect (F (1,67) = 7.29, p <.01). b Significant time effect (F (1,80) = 8.68, p <.01). c Significant time effect (F (1,62) = 9.18, p <.01). d No significant time effect (F (1,1044) < 1, ns). for combat items 2 (p <.05), 3 (p <.01), 4 (p <.01), 6(p <.001), 7 (p <.05), 8 (p <.01) increased significantly for the PTSD Time 2 group. The No PTSD group significantly decreased on item 1 ( p <.05) and increased on item 8 (p <.01). What is the degree to which changes in combat exposure reports affect the dose response relation with PTSD symptoms/diagnosis? The dose-response relation between combat exposure at Time 2 and PTSD diagnosis at Time 2 was nearly double that at Time 1. Using Time 2 low combat exposure (n = 512) as the reference group, the association between PTSD at Time 2 for medium combat exposure (n = 531) was OR = 5.0 (95% CI = ), and for high combat exposure (n = 290) was OR = 15.5 (95% CI = ). Using Time 1 low combat exposure (n = 520) as the reference group, the association between PTSD at Time 2 was for medium combat exposure (n = 566) OR = 3.0 (95% CI = ), and for high combat exposure (n = 291) OR = 7.0 (95% CI = ). The linear regression models, where PTSD symptoms at Time 2 were regressed on combat exposure measured continuously at Time 1, yielded B = 0.76, SE = 0.05, ß =.41, p <.001. When we regressed PTSD symptoms at Time 2 on combat exposure measured continuously at Time 2 we obtained B = 0.90, SE = 0.04, ß =.50, p <.001. The differences in the regression coefficients using Time 1 versus Time 2 reports was statistically significant, χ 2 (1, n = 1462) = 4.78, p <.05. However, the effect size of the changes was small; the β increased by 0.09 when Time 2 combat reports are used instead of Time 1 reports. Thus, the effect of changes in reporting on the relationship between combat exposure and PTSD are much less substantial when the continuous measures of exposures and PTSD were used. DISCUSSION The results of this investigation show that although combat exposure scores show excellent test retest reliability over a 14-year period, changes in combat exposure reports occur. Furthermore, such changes are positively associated with changes in PTSD symptoms. Veterans who met criteria for a presumptive diagnosis of PTSD in 1984 but not in 1998 showed, on average, a significant decrease in combat exposure reported, and those who met criteria in 1998 but not in 1984 showed a significant increase. Although the effect sizes for these changes were small, they resulted in a stronger dose-response relationship between combat
8 10 Koenen et al. Table 3. Mean Difference in z-scores and Tests of Significant Change Over Time for Combat Exposure Item Responses PTSD PTSD PTSD No Time PTSD Group X Both Times Time 1 Time 2 PTSD df (1,1458) a Time (n = 78) (n = 94) (n = 76) (n = 1214) df (3,1458) a Combat #1 Fire a weapon at the enemy Combat #2 Kill the enemy Combat #3 See someone killed Combat #4 See the enemy wounded Combat #5 See our guys wounded Combat #6 See the enemy dead Combat #7 See our dead Combat #8 Find yourself in a situation you thought you d never survive a Degrees of freedom (df ) vary due to missing data. p <.05. p <.01. p <.001. exposure and PTSD when both were assessed at Time 2. This inflation was particularly marked when combat exposure and PTSD were treated as categorical variables. Such models are inherently less precise than the continuous variable model. Finally, increases in exposure reports were specifically predicted by increases in reexperiencing symptoms. This suggests the presence of intrusive memories of the Vietnam combat experience may drive veterans reports of exposure. The pattern of a positive association between changes in PTSD status and changes in combat exposure reporting continued when changes in endorsement and frequency of individual combat items were examined. A higher proportion of those who met the criteria for PTSD in 1998, but not in 1984, changed their responses to at least one item from never to endorsement, than those with PTSD at both periods or those with PTSD in 1984 only. Following this pattern, veterans who had PTSD in 1984, but not in 1998 showed significant decreases in the mean responses on five items and those with PTSD in 1998, but not 1984 showed significant increases on six items. In our study, combat exposure reporting was more consistent (test retest correlation of.87) than that observed by Roemer et al. (1998; test retest correlation of.66) and King et al. (2000; test retest correlation of.61). Moreover, a smaller proportion of our participants showed changes in their endorsement of items, 61.3%, than that found previously (e.g., 91.1% in King et al., 2000 and 88.0% in Southwick et al., 1997). Changes in reporting were more often in terms of frequency (e.g., from rarely to often) than in endorsement. The degree of change in reporting on individual items was also relatively small with changes ranging from.01 to.39 standard deviations. Finally, the great majority of veterans (77.2%) did not change their combat exposure category (low, medium, or high) over the 14-year period. The previous studies with lower reliability took initial combat exposure assessments within 5 days to one-year following the participants return to the United States and participants were not Vietnam veterans. Our survey was not conducted until 1984, 10 years or more after our participants returned from Southeast Asia, which was also the
9 Combat Reporting and PTSD Course 11 case with Janes et al. (1991), who studied Vietnam veterans and found a high test retest reliability. It is possible that the largest changes in exposure reporting occur within the first few years of initial exposure when PTSD symptoms are purported to be especially acute. After that time, few changes in recall of exposure may occur, although the different directions of change observed in Time 1 only and Time 2 only groups do not support this argument. Our participants exposure reports might also have been more consistent due to differences in the nature of the Vietnam experience when compared to that of the Gulf War or Somali peacekeeping experience assessed in previous investigations. Unfortunately, neither objective measures of the actual combat experienced nor baseline measures of combat exposure soon after the exposure occurred are available for our sample. Janes et al. (1991), however, did validate their responses by comparison with whether or not the respondent received a combat-related war medal. Finally, certain psychometric qualities of our CES scale might also have contributed to its greater stability over that used by others (King et al., 2000; Southwick et al., 1997). Scales are designed to provide information on an underlying or latent construct that cannot be observed directly. Scales with multiple items in a Likert-type response format are more reliable than single items or those using a binary response format. Our findings also demonstrate the great difficulty in analyzing individual items within a scale. Because our data do not provide information on the accuracy of participants memories of their combat experiences, we cannot know whether these changes produced inflated or more accurate reports. Changes in reporting were positively associated with changes in PTSD symptoms and thus our data suggest that the very symptoms of PTSD most related to the veteran s memory of his combat experiences reexperiencing symptoms, are most related to increases in exposure reporting. This suggests participants with PTSD had these experiences more readily available to recall when they were filling out the checklist (Tversky & Kahneman, 1973). Furthermore, a large body of literature has documented that the search for meaning is an important part of recovery from traumatic experiences (Herman, 1992 Janoff-Bulman, 1992). One aspect of meaning making involves constructing a coherent narrative of traumatic events within the context of the rest of one s life. It is possible that changes in reporting by our participants with PTSD are related to this search for meaning. Another possible explanation for the association between changes in exposure reporting and changes in PTSD symptoms can be found in the literature on mood dependent recall (Cohen et al., 1988). For example, major depression, a condition commonly comorbid with combat-related PTSD (Kulka et al., 1990) is associated with systematic biases in the processing of information that lead to high-frequency estimates of negative events. Another possibility is that although part of the increase at Time 2 is due to experiencing symptoms among those with PTSD, the decrease in exposure reports among those with PTSD at Time 1 may only be because those veterans have recovered from the disorder and have put their Vietnam experiences behind them. Because the combat exposure reporting over a 14-year period was highly consistent for the overall sample, it appears that the combat exposure measure is a useful instrument for epidemiological studies involving veterans combat experiences. Changes in exposure reporting, when they occur, are associated with changes in PTSD symptoms and these findings, together with those of previous studies call into question the unidirectional dose-response relationship between exposure severity and PTSD that has been important for the validation of the syndrome. Poor recall per se, which we do not observe, would lead to random error in exposure reports and reduced power to test hypotheses. The small but significant changes in recall observed here are systematically biased in favor of the alternative hypothesis (e.g., that risk of developing PTSD increases with exposure severity) are problematic and can lead to distorted dose-response relationships in the type of cross-sectional research most commonly done in the trauma field. Our findings have several practical implications for researchers in the field of trauma and PTSD. First, the correlation of changes in PTSD symptoms with changes in exposure reports over time highlights the need for longitudinal studies of trauma survivors. Issues of recall bias are not absent from such studies. However, longitudinal
10 12 Koenen et al. studies have the ability to disentangle exposure and symptom reports as well as to examine within-individual change over time. For example, using data from the same sample as the present study, we examined the association between combat exposure severity assessed at Time 1 and change in PTSD over the 14-year follow-up and found that combat exposure was the strongest predictor of PTSD course in this sample (Koenen et al., 2003). Second, to improve recall generally, combat assessment in military populations, especially those returning from war theaters, should be done as close in time to the events as possible. Such assessments would also provide a baseline for longitudinal follow-ups. Third, future research might benefit from combining selfreports of exposure with independent sources of data such as military records, contemporary journalists accounts, and other documents (e.g., Dohrenwend et al., 2006). Researchers studying the mental health consequences of civilian traumas such as motor vehicle accidents and natural disasters are increasingly employing independent assessments of trauma severity. These assessments include physician s ratings of medical injury severity and reports by key informants (e.g., parents, spouses; see Hall et al., 2006; Saxe et al., 2005). Such other sources have their own inadequacies and biases. However, their biases are likely to be independent of participants reports of symptomatology. Ultimately, the trauma field would be advanced if better record keeping and quantitative objective measures of combat trauma were available. REFERENCES American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, Cohen, L. H., Towbes, L. C., & Flocco, R. (1988). Effects of induced mood on self report life events and perceived and received social support. Journal of Personality and Social Psychology, 55, Dohrenwend, B. P., Turner, J. B., Turse, N. A., Adams, B. G., Koenen, K. C., & Marshall, R. (2006, August 18). Controversy over the psychologic risks of Vietnam for U.S. veterans: A revisit with new data and methods. Science, 313, Figley, C. R. (1978). Stress disorders among Vietnam veterans. New York: Brunner/Mazel. Frye, J. S., & Stockton, R. (1982). Discriminant analyses of posttraumatic stress disorder among a group of Vietnam veterans. American Journal of Psychiatry, 139, Hall, E., Saxe, G., Stoddard, F., Lopez, C., Kaplow, J., Koenen, K. C., et al. (2006). Posttraumatic stress symptoms in parents of children with acute burns. Journal of Pediatric Psychology, 31, Herman, J. (1992). Trauma and recovery. New York: Basic Books. Janes, G. R., Goldberg, J., Eisen, S. A., True, W. R., & Henderson, W. G. (1991). Reliability and validity of a combat exposure index for Vietnam era veterans. Journal of Clinical Psychology, 47, Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press. King, D. W., & King, L. A. (1991). Validity issues in research on Vietnam veteran adjustment. Psychological Bulletin, 109, King, D. W., King, L. A., Erickson, D. J., Huang, M. T., Sharkansky, E. J., & Wolfe, J. (2000). Posttraumatic stress disorder and retrospectively reported stressor exposure: A longitudinal prediction model. Journal of Abnormal Psychology, 109, Koenen, K. C., Stellman, J. M., Stellman, S. D., & Sommer, J. F., Jr. (2003). Risk factors for course of PTSD among Vietnam veterans: A 14-year follow-up of American Legionnaires. Journal of Consulting & Clinical Psychology, 6, Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam War generation. New York: Brunner/ Mazel. Roemer, L., Litz, B., Orsillo, S., Ehlich, P. J., & Friedman, M. J. (1998). Increases in retrospective accounts of war-zone exposure over time: The rise of PTSD symptom severity. Journal of Traumatic Stress, 11, Saxe, G., Miller, A., Bartholomew, D., Hall, E., Lopez, C., Kaplow, J. B., et al. (2005). Incidence of and risk factors for acute stress disorder in children with injuries. Journal of Trauma, Injury, Infection, and Critical Care, 59, Snow, B. R., Stellman, J. M., Stellman, S. D., & Sommer, J. F., Jr. (1988). Posttraumatic stress disorder among American Legionnaires in relation to combat experience in Vietnam: Associated and contributing factors. Environmental Research, 47,
11 Combat Reporting and PTSD Course 13 Southwick, S. M., Morgan, C. A., III, Nicolau, A. L., & Charney, D. S. (1997). Consistency of memory for combat-related traumatic events in Veterans of Operation Desert Storm. American Journal of Psychiatry, 154, Stellman, J. M., Stellman, S. D., & Sommer, J. F., Jr. (1988a). Social and behavioral consequences of combat and herbicide exposure in Vietnam among American Legionnaires. Environmental Research, 47, Stellman, J. M., Stellman, S. D., & Sommer, J. F., Jr. (1988b). Utilization, attitudes, and experiences of Vietnam era veterans with Veterans Administration health facilities: The American Legion experience. Environmental Research, 47, Stellman, S. D., Stellman, J. M., & Sommer, J. F., Jr. (1988a). Combat and herbicide exposure in Vietnam among a sample of American Legionnaires. Environmental Research, 47, Stellman, S. D., Stellman, J. M., & Sommer, J. F., Jr. (1988b). Health and reproductive outcomes among American Legionnaires in relation to combat and herbicide exposure in Vietnam. Environmental Research, 47, Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for judging frequency and probability. Cognitive Psychology, 5, Yehuda, R., & McFarlane, A. C. (1995). Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. American Journal of Psychiatry, 152,
Persisting Posttraumatic Stress Disorder Symptoms and their Relationship to Functioning in Vietnam Veterans: A 14-Year Follow-Up
Journal of Traumatic Stress, Vol. 21, No. 1, February 2008, pp. 49 57 ( C 2008) Persisting Posttraumatic Stress Disorder Symptoms and their Relationship to Functioning in Vietnam Veterans: A 14-Year Follow-Up
More informationCircumstances of Service and Gender Differences in War-Related PTSD: Findings From the National Vietnam Veteran Readjustment Study
Journal of Traumatic Stress, Vol. 20, No. 4, August 2007, pp. 643 649 ( C 2007) Circumstances of Service and Gender Differences in War-Related PTSD: Findings From the National Vietnam Veteran Readjustment
More informationDo personality traits predict post-traumatic stress?: a prospective study in civilians experiencing air attacks
Psychological Medicine, 2005, 35, 659 663. f 2005 Cambridge University Press doi:10.1017/s0033291704004131 Printed in the United Kingdom Do personality traits predict post-traumatic stress?: a prospective
More informationTraumatic Events and Suicide Attempts
Traumatic Events and Suicide Attempts Findings from a large representative sample of Canadian military personnel Presenter: Shay-Lee Belik Co-Authors: Brian J Cox Gordon JG Asmundson Murray B Stein Jitender
More informationDeployment Stressors, Coping, and. Psychological Well-Being Among Peacekeepers. Luigi Pastò, Ph.D., Don McCreary, Ph.D., Megan Thompson, Ph.D.
Deployment Stressors, Coping, and Psychological Well-Being Among Peacekeepers Luigi Pastò, Ph.D., Don McCreary, Ph.D., Megan Thompson, Ph.D. Defence Research and Development Toronto 1133 Sheppard Avenue
More informationWar-Related Posttraumatic Stress Disorder in Black, Hispanic, and Majority White Vietnam Veterans: The Roles of Exposure and Vulnerability
Journal of Traumatic Stress, Vol. 21, No. 2, April 2008, pp. 133 141 ( C 2008) War-Related Posttraumatic Stress Disorder in Black, Hispanic, and Majority White Vietnam Veterans: The Roles of Exposure and
More informationJournal of Traumatic Stress
Dissociative Symptoms and the Acute Stress Disorder Diagnosis in Children and Adolescents: A Replication of Harvey & Bryant () Journal: Manuscript ID: Wiley - Manuscript type: Keyword - Topics: Keywords
More informationPerceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans
Brief Reports Perceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans Robert H. Pietrzak, Ph.D., M.P.H. Douglas C. Johnson, Ph.D. Marc B. Goldstein, Ph.D. James C. Malley,
More informationManual Supplement. Posttraumatic Stress Disorder Checklist (PCL)
Manual Supplement V OLUME 1, I SSUE 1 N OVEMBER 18, 2014 Posttraumatic Stress Disorder Checklist (PCL) The Posttraumatic Stress Disorder Checklist (PCL) is one of the most frequently used standardized
More informationBM (MM030134); Meiser-Stedman.doc. Acute Stress Disorder and Posttraumatic Stress Disorder in Children
BM-04-07-1038 (MM030134); 2005-07 Meiser-Stedman.doc Acute Stress Disorder and Posttraumatic Stress Disorder in Children and Adolescents Involved in Assaults or Motor Vehicle Accidents Richard Meiser-Stedman,
More informationWar & Post-Traumatic Stress Disorder. Abigail B. Calkin Calkin Consulting Center, Gustavus, Alaska Association Behavior Analysis Int l, May 2015
War & Post-Traumatic Stress Disorder Abigail B. Calkin Calkin Consulting Center, Gustavus, Alaska Association Behavior Analysis Int l, May 2015 Few things are as painful as an invisible wound. Nelson Mandela
More informationPosttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence, and major depression in male twins
Available online at www.sciencedirect.com Comprehensive Psychiatry 49 (2008) 297 304 www.elsevier.com/locate/comppsych Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence,
More informationRelationships Among PTSD Symptoms, Social Support, and Support Source in Veterans With Chronic PTSD
Journal of Traumatic Stress,Vol.21,No.4,August2008,pp.394 401 (C 2008) Relationships Among PTSD Symptoms, Social Support, and Support Source in Veterans With Chronic PTSD Charlene Laffaye VA HSR&D Center
More informationUnderstanding the role of Acute Stress Disorder in trauma
Understanding the role of Acute Stress Disorder in trauma Dr. Trina Hall Police Psychologist Dallas Police Department Lessons Learned: Unfolding the story of PTSD NAMI 2014 Fall Conference Trauma and
More informationMeiser-Stedman, R., Yule, W., Smith, W., Glucksman, E. & Dalgleish, T. (2005). Acute
Meiser-Stedman, R., Yule, W., Smith, W., Glucksman, E. & Dalgleish, T. (2005). Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults and motor vehicle
More informationLong-Term Effects of Military Service on Mental Health among Veterans of the Vietnam War Era
MILITARY MEDICINE, 173, 6:570, 2008 Long-Term Effects of Military Service on Mental Health among Veterans of the Vietnam War Era Matthew S. Brooks, PhD*; Sarah B. Laditka, PhD ; James N. Laditka, DA PhD
More informationThe Contribution of Prior Psychological Symptoms and Combat Exposure to Post Iraq Deployment Mental Health in the UK Military
Journal of Traumatic Stress, Vol. 22, No. 1, February 2009, pp. 11 19 ( C 2009) The Contribution of Prior Psychological Symptoms and Combat Exposure to Post Iraq Deployment Mental Health in the UK Military
More informationAlcohol Use and Alcohol-Related Problems Before and After Military Combat Deployment
Alcohol Use and Alcohol-Related Problems Before and After Military Combat Deployment I. G. Jacobson M. A. K. Ryan, T. I. Hooper, T. C. Smith P. J. Amoroso, E. J. Boyko, G. D. Gackstetter T. S. Wells, N.
More informationMoral Injury and Stress Response Patterns in United States Military Veterans
Modern Psychological Studies Volume 23 Number 1 2017 Moral Injury and Stress Response Patterns in United States Military Veterans Emily L. Ferrell Bowling Green State University, emilylf@bgsu.edu John
More informationTRAUMA SCENE: INITIATION OF THE PROCESS OF POSITIVE RESOLUTION OF TRAUMATIC EXPERIENCES IN GROUPS AND INDIVIDUALS
TRAUMA SCENE: INITIATION OF THE PROCESS OF POSITIVE RESOLUTION OF TRAUMATIC EXPERIENCES IN GROUPS AND Mladen Trlek Ministry of Defence of the Republic of Croatia ABSTRACT The author presents his experience
More informationAustralian Gulf War Veterans. Health Study. Executive Summary
Australian Gulf War Veterans Health Study 2003 Executive Summary Executive summary Introduction The Australian Gulf War Veterans Health Study is the first comprehensive health study of a group of Australian
More informationSHORT REPORT. Is Acute Stress Disorder the optimal means to identify child and adolescent trauma survivors. at risk for later PTSD?
SHORT REPORT Is Acute Stress Disorder the optimal means to identify child and adolescent trauma survivors at risk for later PTSD? Tim Dalgleish PhD, Richard Meiser-Stedman PhD, Nancy Kassam-Adams PhD,
More informationCHAPTER VI RESEARCH METHODOLOGY
CHAPTER VI RESEARCH METHODOLOGY 6.1 Research Design Research is an organized, systematic, data based, critical, objective, scientific inquiry or investigation into a specific problem, undertaken with the
More informationChapter V Depression and Women with Spinal Cord Injury
1 Chapter V Depression and Women with Spinal Cord Injury L ike all women with disabilities, women with spinal cord injury (SCI) may be at an elevated risk for depression due to the double jeopardy of being
More informationEffects of PTSD with Family Members of Veterans. Dr. Barbara Anderson, DSW, MSW, BCD, MAC, LICSW
Effects of PTSD with Family Members of Veterans Dr. Barbara Anderson, DSW, MSW, BCD, MAC, LICSW Learning Objectives: 1) Increased knowledge about Post-Traumatic Stress Disorder and the effects of Post-Traumatic
More informationScreening for Traumatic Stress among Re-deploying Soldiers
R E S E A R C H R E P O R T # 2 0 0 4-0 0 1 US Army Medical Research Unit - Europe Walter Reed Army Institute of Research MAJ Paul Bliese (paul.bliese@us.army.mil) Dr. Kathleen Wright (kathleen.wright@us.army.mil)
More informationWorking in post conflict zone is as stressful as working home
IAMPS, Bucharest, May 10, 2018 Working in post conflict zone is as stressful as working home preliminary evidence from a multi sample PTSD screening Lt.col. Ştefan Liţă, PhD Psychological Services Section,
More informationPost-Traumatic Stress Disorder (PTSD) Among People Living with HIV
Post-Traumatic Stress Disorder (PTSD) Among People Living with HIV Milton L. Wainberg, M.D. Associate Clinical Professor of Psychiatry College of Physicians and Surgeons Columbia University mlw35@columbia.edu
More informationKey words children; maternal posttraumatic stress symptoms; pediatric injury; posttraumatic
Brief Report: The Impact of Maternal Posttraumatic Stress Disorder Symptoms and Child Gender on Risk for Persistent Posttraumatic Stress Disorder Symptoms in Child Trauma Victims Sarah A. Ostrowski, 1
More informationProspective Study of Combat Trauma and Resilience in OIF Veterans
Prospective Study of Combat Trauma and Resilience in OIF Veterans Melissa A. Polusny 1,2,3 Christopher Erbes 2,3 1 Center for Chronic Disease Outcome Research 2 Minneapolis VA Medical Center 3 University
More informationAnger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma Context and Gender
San Jose State University From the SelectedWorks of Miranda E. Worthen December, 2015 Anger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma
More informationPTSD: Armed Security Officers and Licensed Operators. Peter Oropeza, PsyD Consulting Psychologist
PTSD: Armed Security Officers and Licensed Operators Peter Oropeza, PsyD Consulting Psychologist History of PTSD 1678 Swiss physician Johannes Hofer coins the term nostalgia. to describe symptoms seen
More informationDeployment Stressors, Gender, and Mental Health Outcomes Among Gulf War I Veterans
Journal of Traumatic Stress, Vol. 18, No. 2, April 2005, pp. 115 127 ( C 2005) Deployment Stressors, Gender, and Mental Health Outcomes Among Gulf War I Veterans Dawne S. Vogt, 1,2,4 Anica P. Pless, 1
More informationPublished by Elsevier. All rights reserved.
This is the accepted manuscript version of an article accepted for publication in Personality and Individual Differences following peer review. The version of record, S. Hiskey, R. Ayres, L. Andres and
More informationPost-traumatic Stress Disorder following deployment
Post-traumatic Stress Disorder following deployment Fact Sheet Introduction A substantial majority of the Dutch population (approximately 80%) will at some point experience one or more potentially traumatic
More informationDerek Rutter Wake Forest University
Derek Rutter Wake Forest University According to a 2008 Department of Veterans Affairs (VA) study cited by Albright and Thyer (2009), from 2002 until January of 2008, the VA diagnosed 40% of OEF (Operation
More informationThe role of the family in child and adolescent posttraumatic stress following attendance at an. emergency department
The role of the family in child and adolescent posttraumatic stress following attendance at an emergency department Key words: PTSD, children, parents. Running Head: FAMILY INFLUENCES ON CHILD PTSD Abstract
More informationAgenda: Memory. Announcements Recovered memories. Fabricated memories. Logic Evidence. 3bPOT16-1
Agenda: Memory Announcements Recovered memories Logic Evidence Fabricated memories 3bPOT16-1 Announcements Please turn in DRC forms by Tues Research question due in lecture on Tuesday 1 paragraph to 1
More informationThe Many Presentations of Posttraumatic Stress Disorder: An Empirical Examination of Theoretical Possibilities
480151SGOXXX10.1177/215824 4013480151SAGE OpenHickling et al. 2013 The Many Presentations of Posttraumatic Stress Disorder: An Empirical Examination of Theoretical Possibilities SAGE Open January-March
More informationCognitive-Behavioral Assessment of Depression: Clinical Validation of the Automatic Thoughts Questionnaire
Journal of Consulting and Clinical Psychology 1983, Vol. 51, No. 5, 721-725 Copyright 1983 by the American Psychological Association, Inc. Cognitive-Behavioral Assessment of Depression: Clinical Validation
More informationA Cross-Cultural Study of Psychological Well-being Among British and Malaysian Fire Fighters
A Cross-Cultural Study of Psychological Well-being Among British and Malaysian Fire Fighters Mohd. Dahlan Hj. A. Malek, Ida Shafinaz Mohd Universiti Malaysia Sabah Abstract Psychological consideration
More informationThe Impact of Reported Direct and Indirect Killing on Mental Health Symptoms in Iraq War Veterans
Journal of Traumatic Stress, Vol. 23, No. 1, February 2010, pp. 86 90 ( C 2010) The Impact of Reported Direct and Indirect Killing on Mental Health Symptoms in Iraq War Veterans Shira Maguen San Francisco
More informationBURNOUT A RISK FACTOR FOR DEVELOPING PTSD?
2013-2016 BURNOUT A RISK FACTOR FOR DEVELOPING PTSD? Date: 19-7-2016 Name: A. Wapperom Student number: 3952231 Master thesis: Clinical and Health Psychology Under supervision of: A. Rademaker, Prof. dr.
More informationPost-traumatic Stress Disorder among American Legionnaires in Relation to Combat Experience in Vietnam" Associated and Contributing Factors 1
ENVIRONMENTAL RESEARCH 47, 175--192 (1988) Post-traumatic Stress Disorder among American Legionnaires in Relation to Combat Experience in Vietnam" Associated and Contributing Factors 1 BARRY R. SNOW,*'t
More informationAbstract. Sakineh Salamat (1) Ahad Ahangar (2) Robab Farajzadeh (3)
The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male student survivors of the earthquake in the central district of Varzeghan Sakineh Salamat (1) Ahad
More informationPOSTTRAUMATIC GROWTH AND REDUCED PTSD FOR VETERANS THROUGH RECREATION
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 POSTTRAUMATIC GROWTH AND REDUCED PTSD FOR VETERANS THROUGH RECREATION Jessie
More informationMethodology. Outcomes of interest and measures used. Statistical analysis
ht t p: / / doi. or g/ 10. 4038/ s l j ps yc. v8i 2. 8154 Kaushalya and Ponnamperuma since the trauma and other individual and environmental factors may affect the trauma-mental health relationship. These
More informationDISCLOSURE ISSUE AT HAND. Treating Combat Veterans with PTSD: Using Group-Based Exposure Therapy
Treating Combat Veterans with PTSD: Using Group-Based Exposure Therapy LAURA M. WELLS, BSN, RN GEORGINE R. BERENT, EdD, RN-BC DISCLOSURE The speakers have no conflicts of interest, commercial support,
More informationPosttraumatic Stress and Attributions in College Students after a Tornado. Introduction. Introduction. Sarah Scott & Lisa Beck
Posttraumatic Stress and Attributions in College Students after a Tornado Sarah Scott & Lisa Beck Department of Behavioral Sciences Faculty Mentor: Caleb W. Lack, Ph.D. Most adults will be exposed to a
More informationComparison of Two Widely Used PTSD-Screening Instruments: Implications for Public Mental Health Planning
Journal of Traumatic Stress, Vol. 19, No. 5, October 2006, pp. 699 707 ( C 2006) Comparison of Two Widely Used PTSD-Screening Instruments: Implications for Public Mental Health Planning Kenneth J. Ruggiero,
More informationSAMHSA/CMHS Jail Diversion and Trauma Recovery Priority to Veterans
SAMHSA/CMHS Jail Diversion and Trauma Recovery Priority to Veterans David Morrissette, Ph.D. LCSW SAMHSA 240-276-1912 david.morrissette@samhsa.hhs.gov Opportunities for breaking the cycle: Sequential Intercept
More informationTimothy Heeren Department of Biostatistics, Boston University School of Public Health, Boston, MA
Journal of Traumatic Stress, Vol. 23, No. 1, February 2010, pp. 41 51 ( C 2010) PTSD Symptom Increases in Iraq-Deployed Soldiers: Comparison With Nondeployed Soldiers and Associations With Baseline Symptoms,
More informationEffect of Center-Based Counseling for Veterans and Veterans Families on Long-Term Mental Health Outcomes
MILITARY MEDICINE, 178, 12:1328, 2013 Effect of Center-Based Counseling for Veterans and Veterans Families on Long-Term Mental Health Outcomes Meaghan O Donnell, PhD*; Tracey Varker, PhD*; Desmond Perry,
More informationCommentary. Avoiding Awareness of Betrayal: Comment on Lindblom and Gray (2009)
APPLIED COGNITIVE PSYCHOLOGY Appl. Cognit. Psychol. 24: 20 26 (2010) Published online in Wiley InterScience (www.interscience.wiley.com).1555 Commentary Avoiding Awareness of Betrayal: Comment on Lindblom
More informationPREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland
Award Number: W81XWH-061-0573 TITLE: Identification of Risk Factors for Chronic Posttraumatic Stress Disorder (PTSD) PRINCIPAL INVESTIGATOR: M. Tracie Shea, Ph.D. CONTRACTING ORGANIZATION: Brown University
More informationA 1.5-Year Follow-Up of an Internet-Based Intervention for Complicated Grief
Journal of Traumatic Stress, Vol. 20, No. 4, August 2007, pp. 625 629 ( C 2007) A 1.5-Year Follow-Up of an Internet-Based Intervention for Complicated Grief Birgit Wagner and Andreas Maercker Department
More informationPost Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) 2016 Elder Friendly Futures Conference Multiple Voices Shaping Our Communities Panel: New Insights About What Works and What Doesn't in Geriatric Mental Health September
More informationDeployment, Readjustment & Restoration: The PTSD Family Workshop. Stratton VA Medical Center, Albany, NY
Deployment, Readjustment & Restoration: The PTSD Family Workshop Stratton VA Medical Center, Albany, NY Homecoming With deployment comes change, knowing what to expect and how to deal with changes will
More informationTitle registration for a review proposal: Deployment of military personnel to military missions
Title registration for a review proposal: Deployment of military personnel to military missions Joannes Jacobsen, Julie Heidemann, Krystyna Kowalski & Anne- Marie Klint Jørgensen Title registration approval
More informationExploring. military 2002.
Exploring Initial Outcomes and Service Utilization of Homeless Veterans in a Jail Diversion and Trauma Recovery Program Stacey Stevens Manser, Sam Shore, Gilbert Gonzales, Laura Kaufman INTRODUCTION In
More informationCounseling Troops, Veterans and Their Families Webinar Sponsored by North Carolina Central University
Counseling Troops, Veterans and Their Families Webinar Sponsored by North Carolina Central University Department of Counselor Education Durham North Carolina Gwendolyn Keith Newsome, PhD, LPC, NCC Coping
More informationCRITICALLY APPRAISED PAPER (CAP)
CRITICALLY APPRAISED PAPER (CAP) Biggs, Q. M., Fullerton, C. S., McCarroll, J. E., Liu, X., Wang, L., Dacuyan, N. M.,... Ursano, R. J. (2016). Early intervention for post-traumatic stress disorder, depression,
More informationSelf-reported problems: a comparison between PTSDdiagnosed veterans, their spouses, and clinicians
Behaviour Research and Therapy 40 (2002) 853 865 www.elsevier.com/locate/brat Self-reported problems: a comparison between PTSDdiagnosed veterans, their spouses, and clinicians D. Biddle a, b,*, P. Elliott
More informationPathways to Inflated Responsibility Beliefs in Adolescent Obsessive-Compulsive Disorder: A Preliminary Investigation
Behavioural and Cognitive Psychotherapy, 2011, 39, 229 234 First published online 23 November 2010 doi:10.1017/s1352465810000810 Pathways to Inflated Responsibility Beliefs in Adolescent Obsessive-Compulsive
More informationFebruary 4 & 5, 2013
February 4 & 5, 2013 Check Homework The Things YOU Carry Finish Reading: The Things They Carried (Chapter 1) TTTC: Chapter 1 Quiz! (Turn in Ch. 1 Notes/Worksheet) Euphemisms Notes Understanding Euphemisms
More informationThe events of Sept. 11, 2001, highlighted the importance
Article Acute Stress Disorder, Posttraumatic Stress Disorder, and Depression in Disaster or Rescue Workers Carol S. Fullerton, Ph.D. Robert J. Ursano, M.D. Leming Wang, M.S. Objective: The events of Sept.
More informationIllness Factors and Child Behavior Before and During Pediatric Hospitalization
Illness Factors and Child Behavior Before and During Pediatric Hospitalization William G. Kronenberger 1, Bryan D. Carter 2, Valerie M. Crabtree 2, Laurie M. Grimes 2, Courtney Smith 2, Janet Baker 2,
More informationEditorial Comments: Complex Developmental Trauma
Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 385 388 ( C 2005) Editorial Comments: Complex Developmental Trauma The diagnosis of posttraumatic stress disorder (PTSD) was included in the
More informationThe massive pressures of war have long been recognized
Article Trajectories of : A 20-Year Longitudinal Study Zahava Solomon, Ph.D. Mario Mikulincer, Ph.D. Objective: This study assessed the psychopathological effects of combat in veterans with and without
More informationChapter 3. Psychometric Properties
Chapter 3 Psychometric Properties Reliability The reliability of an assessment tool like the DECA-C is defined as, the consistency of scores obtained by the same person when reexamined with the same test
More informationThe effect of job demands and social support on peacekeepers stress and sense of coherence after deployment
Finnish Defence Research Agency The effect of job demands and social support on peacekeepers stress and sense of coherence after deployment ISMS Annual Conference 2015, Finnish National Defence University
More informationUnit Cohesion and PTSD Symptom Severity in Air Force Medical Personnel
MILITARY MEDICINE, 175, 7:482, 2010 and PTSD Symptom Severity in Air Force Medical Personnel Benjamin D. Dickstein, MA * ; Carmen P. McLean, PhD * ; Jim Mintz, PhD ; Lauren M. Conoscenti, PhD * ; Maria
More informationHealth Care Utilization by Veterans with Posttraumatic Stress Disorder: A Spouse/Intimate Partner Perspective By: Cassandra Buchanan, Nursing
1 Health Care Utilization by Veterans with Posttraumatic Stress Disorder: A Spouse/Intimate Partner Perspective By: Cassandra Buchanan, Nursing 2 Introduction With Operation Iraqi Freedom (OIF) and Operation
More informationTrauma Centrality and PTSD Symptom Severity in Adult Survivors of Childhood Sexual Abuse
Trauma Centrality and PTSD Symptom Severity in Adult Survivors of Childhood Sexual Abuse The Harvard community has made this article openly available. Please share how this access benefits you. Your story
More informationWhich Instruments Are Most Commonly Used to Assess Traumatic Event Exposure and Posttraumatic Effects?: A Survey of Traumatic Stress Professionals
Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 1 5 ( C 2005) Which Instruments Are Most Commonly Used to Assess Traumatic Event Exposure and Posttraumatic Effects?: A Survey of Traumatic
More informationConsistency of Memory for Combat-Related Traumatic Events in Veterans of Operation Desert Storm
CONSISTENCY Am J Psychiatry OF 154:2, MEMORY February 1997 Consistency of Memory for Combat-Related Traumatic Events in Veterans of Operation Desert Storm Steven M. Southwick, M.D., C. Andrew Morgan III,
More informationPosttraumatic Stress Disorder: Trauma Types
Being Male in Indian Country: The Risk of Trauma, PTSD and Alcoholism Spero M. Manson, Ph.D. Professor and Head American Indian and Alaska Native Programs School of Medicine University of Colorado Denver
More informationReactions to and Memories for the September 11, 2001 Terrorist Attacks in Adults with Posttraumatic Stress Disorder
APPLIED COGNITIVE PSYCHOLOGY Appl. Cognit. Psychol. 17: 1081 1097 (2003) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/acp.987 Reactions to and Memories for the September
More informationAnhedonia and emotional numbing in combat veterans with PTSD
Behaviour Research and Therapy 44 (2006) 457 467 www.elsevier.com/locate/brat Shorter communication Anhedonia and emotional numbing in combat veterans with PTSD Todd B. Kashdan a,, Jon D. Elhai b, B. Christopher
More informationBook review. Conners Adult ADHD Rating Scales (CAARS). By C.K. Conners, D. Erhardt, M.A. Sparrow. New York: Multihealth Systems, Inc.
Archives of Clinical Neuropsychology 18 (2003) 431 437 Book review Conners Adult ADHD Rating Scales (CAARS). By C.K. Conners, D. Erhardt, M.A. Sparrow. New York: Multihealth Systems, Inc., 1999 1. Test
More informationS P O U S A L R ES E M B L A N C E I N PSYCHOPATHOLOGY: A C O M PA R I SO N O F PA R E N T S O F C H I LD R E N W I T H A N D WITHOUT PSYCHOPATHOLOGY
Aggregation of psychopathology in a clinical sample of children and their parents S P O U S A L R ES E M B L A N C E I N PSYCHOPATHOLOGY: A C O M PA R I SO N O F PA R E N T S O F C H I LD R E N W I T H
More informationAPNA 30th Annual Conference Session 3037: October 21, 2016
Erica Mumm, DNP, MSN, RN American Psychiatric Nurses Association 30 th Annual Conference October 19 th 22 nd, 2016 Disclosure This presenter has no conflict of interest to disclose. 2 OEF & OIF: A Different
More informationObsessive Compulsive Symptoms Predict Posttraumatic Growth: A Longitudinal Study
Journal of Loss and Trauma International Perspectives on Stress & Coping ISSN: 1532-5024 (Print) 1532-5032 (Online) Journal homepage: http://www.tandfonline.com/loi/upil20 Obsessive Compulsive Symptoms
More informationDESIGN TYPE AND LEVEL OF EVIDENCE: Randomized controlled trial, Level I
CRITICALLY APPRAISED PAPER (CAP) Hasan, A. A., Callaghan, P., & Lymn, J. S. (2015). Evaluation of the impact of a psychoeducational intervention for people diagnosed with schizophrenia and their primary
More informationDiagnosis and Assessment of PTSD: A Report to the Institute of Medicine
Diagnosis and Assessment of PTSD: A Report to the Institute of Medicine Matthew J. Friedman, MD, PhD Executive Director, VA NCPTSD Definition of Mental Disorder A clinically significant behavioral or psychological
More informationMale-Perpetrated Domestic Violence: Testing a Series of Multifactorial Family Models
Male-Perpetrated Domestic Violence: Testing a Series of Multifactorial Family Models By Lynda A. King and Daniel W. King 2004 NCJ 199712 Lynda A. King, Ph.D., is with the Women s Health Sciences Division,
More informationMichael Waller 1*, Susan A Treloar 1, Malcolm R Sim 2, Alexander C McFarlane 3, Annabel C L McGuire 1, Jonathan Bleier 4 and Annette J Dobson 1
Waller et al. BMC Psychiatry 2012, 12:88 RESEARCH ARTICLE Open Access Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following
More informationFactor Analysis of Gulf War Illness: What Does It Add to Our Understanding of Possible Health Effects of Deployment?
October 3, 2006 Factor Analysis Examples: Example 1: Factor Analysis of Gulf War Illness: What Does It Add to Our Understanding of Possible Health Effects of Deployment? 1 2 2 Susan E. Shapiro, Michael
More informationTHE RELATIONSHIP BETWEEN LIFE SATISFACTION AND ATTACHMENT STYLES WITH PSYCHOLOGICAL WELL-BEING OF CHILDREN ON COVERED BY BEHZISTEY IN TEHRAN
THE RELATIONSHIP BETWEEN LIFE SATISFACTION AND ATTACHMENT STYLES WITH PSYCHOLOGICAL WELL-BEING OF CHILDREN ON COVERED BY BEHZISTEY IN TEHRAN *Masomeh Azimi Qadeyklaey and Farideh Dokaneheei Fard Department
More informationCRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION
CRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION In military veterans, what is the effect of virtual reality exposure therapy (VRE) on posttraumatic stress disorder (PTSD) and depressive symptoms, as
More informationCatastrophe in the Workplace: Impact of Indirect Trauma Exposure on Hospital Social Workers
Catastrophe in the Workplace: Impact of Indirect Trauma Exposure on Hospital Social Workers Karen Badger, Ph.D. University of Kentucky Lexington, Kentucky Statement of the Research Problem Work related
More informationSHORT REPORTS. David W. Foy Pepperdine University. Daniel W. King and Lynda A. King. John A. Fairbank
Journal of Abnormal Psychology 1999, Vol. 108, No. 1, 164-170 In the public domain SHORT REPORTS Posttraumatic Stress Disorder in a National Sample of Female and Male Vietnam Veterans: Risk Factors, War-Zone
More informationNIH Public Access Author Manuscript Int J Cardiol. Author manuscript; available in PMC 2014 November 20.
NIH Public Access Author Manuscript Published in final edited form as: Int J Cardiol. 2014 October 20; 176(3): 1042 1043. doi:10.1016/j.ijcard.2014.07.290. The Association of Posttraumatic Stress Disorder
More informationMILD TRAUMATIC BRAIN INJURY (mtbi) is
J Head Trauma Rehabil Vol. 27, No. 1, pp. 75 82 Copyright c 2012 Wolters Kluwer Health Lippincott Williams & Wilkins Frequency of Mild Traumatic Brain Injury in Iraq and Afghanistan: Are We Measuring Incidence
More informationPhysiological Predictors of Posttraumatic Stress Disorder
Journal of Traumatic Stress, Vol. 23, No. 6, December 2010, pp. 775 784 ( C 2010) CE ARTICLE Physiological Predictors of Posttraumatic Stress Disorder Cassidy A. Gutner Boston University Suzanne L. Pineles
More informationREPORT DOCUMENTATION PAGE
REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions,
More informationExamining the role of unit cohesion as a moderator of the relationship between warfare exposure and PTSD
Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2014 Examining the role of unit cohesion as a moderator of the relationship between warfare exposure and PTSD
More informationACEs in forensic populations in Scotland: The importance of CPTSD and directions for future research
ACEs in forensic populations in Scotland: The importance of CPTSD and directions for future research Thanos Karatzias School of Health & Social Care Professor of Mental Health Director of Research Overview
More informationDiagnostic performance of the PTSD checklist and the Vietnam Era Twin Registry PTSD scale
Diagnostic performance of the PTSD checklist and the Vietnam Era Twin Registry PTSD scale K. Magruder, Ralph H. Johnson VA Medical Center D. Yeager, Ralph H. Johnson VA Medical Center J. Goldberg, VA Puget
More informationPosttraumatic Stress Disorder and Suicidal Behavior: Current Understanding and Future Directions
Posttraumatic Stress Disorder and Suicidal Behavior: Current Understanding and Future Directions Jaimie L. Gradus, DSc, MPH Epidemiologist, National Center for PTSD, VA Boston Healthcare System Associate
More information